Factors Associated With Return to Work After Acute Myocardial Infarction in China

Zihan Jiang, Rachel P Dreyer, John A Spertus, Frederick A Masoudi, Jing Li, Xin Zheng, Xi Li, Chaoqun Wu, Xueke Bai, Shuang Hu, Yun Wang, Harlan M Krumholz, Hong Chen, China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Collaborative Group, Zihan Jiang, Rachel P Dreyer, John A Spertus, Frederick A Masoudi, Jing Li, Xin Zheng, Xi Li, Chaoqun Wu, Xueke Bai, Shuang Hu, Yun Wang, Harlan M Krumholz, Hong Chen, China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Collaborative Group

Abstract

Importance: Return to work is an important indicator of recovery after acute myocardial infarction. Little is known, however, about the rate of returning to work within the year after an acute myocardial infarction in China, as well as the factors associated with returning to work after an acute myocardial infarction.

Objectives: To determine the rate of return to work within 12 months after acute myocardial infarction, classify the reasons why patients did not return to work, and identify patient factors associated with returning to work.

Design, setting, and participants: This prospective cohort study, conducted in 53 hospitals across 21 provinces in China, identified 1566 patients who were employed at the time of the index acute myocardial infarction hospitalization and participating in the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction. Data collected included patients' baseline characteristics; employment status at 12 months after acute myocardial infarction; and, for those who were not employed at 12 months, potential reasons for not returning to work. A logistic regression model was fitted to identify factors associated with returning to work at 12 months. Data were collected from January 1, 2013, through July 17, 2014, and statistical analysis was conducted from August 9, 2016, to August 15, 2018.

Main outcomes and measures: Return to work, defined as rejoining the workforce within 12 months after discharge from hospitalization for the index acute myocardial infarction.

Results: Of 1566 patients (130 women and 1436 men; mean [SD] age, 52.2 [9.7] years), 875 patients (55.9%; 95% CI, 53.4%-58.3%) returned to work by 12 months after acute myocardial infarction. Among the 691 patients who did not return to work, 287 (41.5%) were unable to work and/or preferred not to work because of acute myocardial infarction and 131 (19.0%) retired early owing to the acute myocardial infarction. Female sex (relative risk, 0.65; 95% CI, 0.41-0.88), a history of smoking (relative risk, 0.82; 95% CI, 0.65-0.98), and in-hospital complications during the index acute myocardial infarction (relative risk, 0.96; 95% CI, 0.93-0.99) were associated with a lower likelihood of returning to work.

Conclusions and relevance: Almost half of the previously employed Chinese patients did not return to work within 12 months after acute myocardial infarction. Female sex, history of smoking, and in-hospital complications were associated with a lower likelihood of returning to work.

Trial registration: ClinicalTrials.gov Identifier: NCT01624909.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Spertus reported being supported by grants from Gilead, Genentech, Lilly, Amorcyte, and EvaHeart; and having a patent for the Seattle Angina Questionnaire with royalties paid. Dr Krumholz reported being a recipient of research agreements from Medtronic and Johnson & Johnson (Janssen), through Yale University, to develop methods of clinical trial data sharing; being the recipient of a grant from the US Food and Drug Administration and Medtronic to develop methods for postmarket surveillance of medical devices; working under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures; serving as chair of a cardiac scientific advisory board for UnitedHealth; serving as a participant/participant representative of the IBM Watson Health Life Sciences Board; and being the founder of Hugo, a personal health information platform. No other disclosures were reported.

Figures

Figure 1.. Flowchart of Patient Enrollment
Figure 1.. Flowchart of Patient Enrollment
AMI indicates acute myocardial infarction; China PEACE Prospective Study of AMI, China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction.
Figure 2.. Adjusted Risk Ratio (RR) of…
Figure 2.. Adjusted Risk Ratio (RR) of Returning to Work Within 12 Months After Discharge for Acute Myocardial Infarction
The patient characteristics associated with return to work at 12 months are shown in the first column.

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